Penetrating carrier, anti-fungal composition using the same and method for treatment of dermatophytes

ABSTRACT

A liquid carrier for topical administration is provided that contains a mineral oil, turpentine and, optionally, camphor, and optionally other terpenoid components containing pinene, and its use to provide an antifungal composition a mixture of antifungal essential oils and the carrier system, wherein the mixture of antifungal essential oils includes an effective amount of each of eucalyptus globulus, peppermint, cedarwood, and Manuka;
         along with the use of this composition in the topical treatment of fungal infection, particularly of the nail.

BACKGROUND OF THE INVENTION

1. Field of Invention

The present invention relates to a carrier for a topical medicamenthaving improved ability to penetrate thick keratinous tissues, a topicalanti-fungal composition useful for the treatment of dermatophytesinfection in the nail bed and nail plate and a method for treatingfungal nail infections using the composition.

2. Discussion of the Background

Dermatophytes are filamentous fungi that are commonly found in plantsand soil. Nail invasion by these organisms cause disease, withthickening, discoloration, odor, decay, lysis (loosening of the nailplate from the base of the nail bed), and deformity such as increasedcurvature of the nail plate. In addition to dermatophytes, candidaalbecans (a yeast) is also a common pathogen. A small number of diseasesare also caused by molds, considered non-dermatophytes. The medical namefor fungal nail disease is onychomycosis. Fungi live in the nail bedunder the toenail and also involve the nail itself. The fungus is aparasite, and lives on the keratin, by dissolving the keratin withenzymes known as keratinases. The most common organisms are TrichophytanRubrum (which causes between 80-90% of infections), TrichophytanMentagrophytes, Epidermophytan Floccosum and Candida Albecans.

Many times the fungi will cause the nail to produce excess keratin, acondition known as hyperkeratosis, causing the nail to be thicker andoften deformed. Additionally, the thicker toenail can cause pain,leading to ingrown nails, and even difficulty in wearing shoes due tothe thickness. The typical treatment for this condition involves havinga podiatrist debride or manually thin the nail, often at great cost tothe patient, insurance, and Medicare.

Nails are made of layers of Keratin a protein, which has lipid bilayers,phospholipid cell membranes and connections between the cells calleddesmosomes. The cells of the toenails are dead, so penetration relies ondiffusion of non polar lipids (non charged) across these structures. Themore fat soluble, the better the penetration. To effectively treatonychomycosis, it is necessary to get the antifingal medicine throughthe nail plate and keratin, which may be very thick, and penetrate tothe site where the organism lives.

One U.S. study suggested a prevalence of Onychomycosis of 18.5% with thenumber of persons affected on the rise, which may be partly accountedfor by the aging U.S. population. Onychomycosis affects 32% of thepeople between 60-70 years of age, and some studies suggest it mayaffect 48% of the population by age 70. Onychomycosis has a strongerprevalence in immunosuppressed people, such as those with diabetes, poorcirculation, or HIV infection. Toenail infections are several times morecommon than fingernail infections. Several oral medicines are effectivein treating these conditions, such as Lamisil and Sporonox. However,these medicines are prescription medications, costing the patient asmuch as $1000 to treat an infection, and requiring extraneous lab tests,because they can cause damage to the liver and kidneys as well as otherside effects.

Topical treatments have historically been somewhat ineffective. One suchtopical treatment is Penlac, which is at the top of the list, butrequires a prescription, monthly treatments by the doctor to debride orremove the dead nail tissue and is expensive (with a small bottle of 6cc costing typically over $150). Additionally it is only indicated fordisease of the nail distal to the lunula-white half moon. According tothe Physician's Desk Reference (PDR), two studies using Penlac indicatecure rates of 5.5% and 8.5%, and an almost cure rate of 6.5% and 12%.Further, the PDR states that Penlac is not effective against the mostcommon fungus to infect nails, Trichophytan Rubrum. There other OTCmedicines but proof of their efficacy is difficult to determine.

SUMMARY OF THE INVENTION

Accordingly, one object of the present invention is to provide a carrierfor topical medicaments that can penetrate and transport a broadspectrum of antifungal compounds through keratinous tissues, such asnail bed and nail plate.

A further object of the present invention is to provide a topicalcomposition for treatment of fungal infections using this carrier.

A further object of the present invention is to provide a topicalanti-fungal composition effective at treating onychomycosis.

A further object of the present invention is to provide a topicalanti-fungal composition that contains only GRAS ingredients, andrequires no debridement during treatment.

A further object of the present invention is to provide a method for thetopical treatment of nail infections using such anti-fungalcompositions.

These and other objects of the present invention have been satisfied bythe discovery of a liquid carrier system comprising a mineral oil andturpentine, and optionally, camphor and/or one or more additionalterpenoid components containing pinene, and its use to prepare ananti-fungal composition, comprising:

an effective anti-fungal amount of a mixture of antifungal essentialoils and the carrier system,

wherein the mixture of antifungal essential oils comprises effectiveamounts of each of eucalyptus globulus, peppermint, cedarwood, andmanuka.

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to a liquid carrier system comprising amineral oil, turpentine, and optionally, camphor and/or one or moreadditional terpenoid components containing pinene. When combined withone or more active ingredients, this carrier system provides penetrationof keratinous tissue and transport and delivery of the active ingredientto the site in need thereof.

The present invention further relates to an anti-fungal composition,comprising:

an effective anti-fungal amount of a mixture of antifingal essentialoils and a carrier system,

wherein the mixture of antifungal essential oils comprises effectiveamounts of each of eucalyptus globulus, peppermint, cedarwood, andManuka; and

wherein the carrier system is as described above.

The antifungal composition of the present invention is preferably in theform of a liquid, containing slow-to-evaporate whole antifungal oils ina proven carrier. The carrier system is one important aspect of thepresent invention, as it provides the ability to take the fat solublesubstances and penetrate the thick keratin layer of the nail in aneffective manner. The combination of antifungal essential oils has beenfound to be effective on most or all of the different types of fungalinfections of the nail (particularly the toenail) in a broad spectrum.Further, the combination preferably helps overcome the resistance of thedifferent fungi as they mutate and change in an attempt to avoid beingdestroyed. The composition is preferably in a liquid form, since liquidshave the best penetration. Further, the composition is most preferablyin a liquid carrier that is a non evaporative substance, particularlypreferably the carrier system of the present invention. Withevaporation, the carrier tends to disappear before it can penetrate thethick nail plate.

In a most preferred embodiment, the carrier of the present invention,when put on a non absorbtive material, does not significantly evaporateover a period of days, and most preferably has essentially a negligiblevapor pressure under normal atmospheric conditions, thus exhibiting noobservable evaporation to any significant extent.

The conventional approach to treatment of nail fungus is to debride thenail manually to remove as much of the keratin caused by the thickeningof the fungus, in order that penetrations of antifungal medicines canresult. Additionally application of antikeratolytics, such as salicylicacid or urea, are also used to remove keratin debris. The reason forthis is that keratin is layered as a protective shield againstpenetration of substances. It is found in the skin as well. Someconventional products use various substances to enhance penetration withlimited success such as alcohol, polyethylene glycol, triglycerides,fatty acids, liposomes, nanospheres, or lecithin. These all have limitedability to penetrate the skin and are essentially of no use on a thicklayer of keratin in toenails. Because the cell membranes are made ofphospholipids, fat soluble substances can pass between cells calleddesmosome connections, through cell membranes and through keratin. U.S.Pat. No. 6,344,190 discloses a composition for treatment ofdermatophytes that contains several essential oil components and acarrier system. However, the disclosed compositions do not teach acarrier system or combination of specific essential oils such asrequired in the present invention composition. Namely, the only carriersystems specifically named in the '190 patent appear to be an alcoholester, such as isoamyl alcohol (an evaporative carrier) or acommercially available product designated VICKS VAPO-RUB (a thick greasycarrier system containing a mixture of unidentified ingredients).

The present invention composition and method use a carrier thatpenetrates the keratin by being a fat soluble substance, such ashydrocarbons. One preferred carrier is mineral oil, which is a fatsolvent, when combined with turpentine and, optionally, with camphor (adistillation derivative obtained from pine or from the cinnamomumcamphor tree, a monoterpenoid), and/or one or more other terpenoidsubstances. The liquid carrier of the present invention comprises thecombination of a mineral oil and pine(turpentine). This preferredcombination of carrier components helps to pull the antifungal essentialoils of the present invention antifungal composition through the thicklayers of keratin found in the nail. The present composition does notrequire debridement of the nails or keratolytics in order to beeffective. The present composition has been found effective in treatingnail fungus just by application directly to the nail surface on aregular basis. However, while not requiring the above, the presentcomposition can be used in combination with debridement or addedkeratolytics, if desired.

Additionally, the components contained in the present inventioncomposition are considered GRAS (generally recognized as safe) underU.S. FDA regulations, and therefore can be sold as an over-the-countercomposition.

To reach the desired area the carrier must be fat soluble (i.e., willdissolve in fat, remain soluble and forms an essentially homogeneoussolution with fat) and the antifungal agents must also be fat soluble topenetrate these intercellular fat soluble connections, as well as thekeratin. To be effective, the formula must have the ability to penetratethe toenail (i.e. move across phospholipid cell membrane, fatty bilayerof keratin (through keratin), and desmosomes. Most conventionalantifungal compositions are not effective on toenails (absentdebridement or keratolytics) because they are not able to get theantifungal composition thru the nail plate and skin under the nailcalled the nail bed.

The present composition has been found to be effective on substantiallyall types of nail fungus disorders, whether of distal type, lateraltype, superficial type, or proximal type involving the whole nail.Studies using sequential photography have shown its effectiveness as 40%cure rate and 25% almost cure rate/improvement. Importantly, the presentcomposition does not require debribement of the nail to be effective,because the vehicle for penetration of the nail plate works regardlessof the thickness of the nail. The composition is also broad spectrum,which is necessary because these organism are polymorphic and can changetheir resistance. The combination of multiple effective antifungalessential oils in the present composition allow for this. While thepreferred use for the present composition is treatment of onychomycotictoenails, the composition can be used to treat skin fungus infections aswell. Upon treatment of nail fungus with the present composition, it hasbeen noted that the nails appear to grow faster as treatment progresses.This may be due to increased nail growth as a result of decreasing thefungal involvement, or by stimulation of the nail matrix by the presentcomposition.

The present composition can be in any form suitable for topicalapplication, particularly to the nail surface. The composition canpreferably take a form including, but not limited to, liquid solutions,liquid suspensions, liquid dispersions, gels, jellys, cremes, andointments. Most preferably for application to the nail, the compositionis in the form of a liquid, either in solution, suspension or dispersionform. For use on skin, either liquid or gel/jelly forms are preferred.In use on skin, the composition preferably contains petrolatum as anadditional carrier. The petrolatum may be as is, or may be treated withultraviolet light (preferably using a cold UV lamp), which has beenreported to provide additional healing properties through a propertycalled “radiolatum”.

Although not required in the present composition, the composition canoptionally contain one or more keratolytic agents, such as salicylicacid or urea, as well as other conventional additives and/or auxiliariesused in topical compositions. Such conventional additives or auxiliariesinclude, but are not limited to, fillers, colorants or dyes, skinconditioners, MSM (methylsulfoxymethane), etc.

Nail fungi are parasites that live and grow in the nail and underlyingskin called nail bed. The fungus lives off the keratin of the nail andcauses the nail to produce more keratin. The fungus produces spores andtentacles called hyphae that grow out. The fungus also produceskeratinases to eat away at the keratin as well. The keratin is aprotein, and like the outside layer of the skin, tends to prevent thingsfrom penetrating. When the fungus does invade the toenail, it eats awayand rots it, much like a rotting piece of wood. While plants and treeshave natural antibiotic oils in their leaves and bark, to keep awaythese invaders, human tissue does not have the same advantage. Based onthis principal, the present composition uses a mixture of antifungalessential oils. However, the oils alone still have a difficult timepenetrating the thick keratin nail plate. Prior to the presentinvention, so far as is known by the present inventor, no one has founda way to do this effectively as a topical agent. With the presentinvention composition, the antifungal essential oils are carried ordelivered through this tough, up to now impenetrable, barrier. Thepresent composition provides a mixture of antifungal essential oils thatis a broad spectrum antifingal combination so as to cover all the mutantresistances that develop, prevents keep the fungus from growing, and isnot harmful to the nail or nail matrix.

The present invention carrier or delivery system comprises a mineral oil(lipid solvent), and turpentine, and optionally camphor and/or one ormore additional terpenoids containing pinene. (In addition, several ofthe anti-fungal essential oils can act both in an antifungal role aswell as a carrier role, such as camphor (which can be distilled frompine).

The antifungal essential oils are preferably plant extracts and are fatsoluble. The composition comprises a mixture of antifungal essentialoils comprising camphor, eucalyptus globulus, peppermint, cedarwood oil(cedar atlas from cedrus atlantica), and manuka oil (from lepospermumscoparium). In addition to these, the mixture of antifungal essentialoptionally can further comprise amounts of sage, juniper, clove,lavender, cinnamon bark and leaf oil, grapeseed, jojoba oil, anise,rosewood, eucalyptus citroidora, tea tree (from malaleuca alternafolia),and nutmeg. Importantly, the mixture of antifungal essential oils ispreferably substantially free of the presence of thymol. Within thecontext of the present invention, the term “substantially free ofthymol” is used to indicate that the essential oils used do not havedetectable amounts of thymol, as determined by gas chromatographicanalysis of the essential oil itself. In one embodiment of the presentinvention, the composition further comprises grapeseed extract andanise, which together increase effectiveness of the composition againstyeasts known as polygyols, potentially up to a 30-40 fold increase ineffectiveness.

The amount of each antifungal essential oil used is preferably in therange of from 0.1% to 40%, based on total composition amount. Morepreferably, the antifungal essential oils are present in an amount offrom 0.1% to 10%, most preferably from 1% to 7%, based on totalcomposition amount. These amounts do not have to be the same for eachantifungal essential oil, and the amount of each individual essentialoil present in the composition is independent of the identity or amountof other components used. The carrier components are preferably each,independently, present in amounts of from 0.1-40% by weight, based ontotal composition amount. More preferably, the mineral oil is present inan amount of from 5-30% by weight. The turpentine can also be in similaramounts as mineral oil, with camphor (when present) being presentpreferably in smaller amounts, comparable to the amount of individualantifungal essential oils. Camphor can act both as part of the carriersystem and as one of the antifungal essential oils of the antifungalcomposition of the present invention. The carrier system itself can beused for delivery of any desired fat soluble active agent(s),particularly for treatment of disorders related to keratinous tissues.

The method for using the present composition comprises application ofthe composition directly to the nail surface. Preferably, theapplications are performed from 1 to 4 applications per day, and arecontinued until the infection is eliminated, preferably for a period of3 to 12 months. Afterward, the composition can be used on a regularbasis (approximately every 2-3 days) to prevent reoccurrence of theinfection and encourage nail health. More preferably, the composition isapplied from 1 to 2 times per day directly to the nail surface, mostpreferably immediately after bathing. The application is performed usingany type of applicator, including but not limited to, fingers, brushes,swabs, etc. The application should preferably be sufficient to form athin film of the composition on most or all of the nail surface. Whilethe application can also include the skin area surrounding the nail,this can cause temporary skin irritation in some patients.

EXAMPLES

Based on application to a patient group of over 150 patients,application of the antifungal composition of the present invention gavea conservative estimate of 40-60% cure, with a rate of cure/improvementin the 66-85% range. Patients were instructed to apply the compositiontwice daily after bathing, then were individually observed on a monthlybasis. Pictures can be taken to document recovery. If complete nailinvolvement was present, the total nail may take up to 9-12 months togrow out. Less involvement takes a shorter period of time, typically ⅓-½of the time.

A most preferred example of the present antifungal composition containsthe following:

Essential Oils Eucalyptus globulus 5% Peppermint 5% Cedarwood 5% Manuka5% Sage 5% Juniper 5% Clove 5% Lavender 5% Cinnamon bark and leaf oil 5%Jojoba oil 5% Grapeseed 5% Anise 5% Tea Tree 5% Rosewood 5% Eucalyptuscitroidia 2.5%   Nutmeg 5% Carrier System Mineral oil 12.5%   Camphor 5%Turpentine 5%

1. A fat-soluble anti-fungal composition consisting essentially of: aneffective anti-fungal amount of a mixture of fat-soluble antifungalessential oils and a fat-soluble carrier system, wherein the mixture offat-soluble antifungal essential oils comprises an amount of from 0.1 to10% by weight, based on total composition amount, of each of Eucalyptusglobulus oil, peppermint oil, cedarwood oil, and manuka oil; and whereinthe fat-soluble carrier system comprises a mineral oil and turpentine,each in an amount of from 0.1-40% by weight, based on total compositionamount.
 2. A fat soluble anti-fungal composition consisting essentiallyof: an effective anti-fungal amount of a mixture of fat-solubleantifungal essential oils and a fat-soluble carrier system, wherein themixture of fat-soluble antifungal essential oils comprises an amount offrom 0.1 to 10% by weight, based on total composition amount, of each ofEucalyptus globulus oil, peppermint oil, cedarwood oil, and manuka oil;and one or more of sage oil, juniper oil, clove oil, lavender oil,cinnamon (Cinnamomum) bark and leaf oil, jojoba oil, grapeseed oil,anise oil, tea tree oil, rosewood oil, Eucalyptus citroidora oil, andnutmeg oil, wherein the fat-soluble carrier system comprises a mineraloil and turpentine, each in an amount of from 0.1-40% by weight, basedupon total composition amount.
 3. The fat-soluble anti-fungalcomposition of claim 1, wherein said mixture of fat-soluble antifungalessential oils is substantially free of thymol.
 4. The fat-solubleanti-fungal composition of claim 1, wherein said fat-soluble carriersystem further contains camphor.
 5. The fat-soluble anti-fungalcomposition of claim 1, wherein the composition is in a form selectedfrom the group consisting of liquid solutions, liquid suspensions,liquid dispersions, gels, jellies, crèmes, and ointments.
 6. Thefat-soluble anti-fungal composition of claim 5, wherein said compositionis in a form selected from the group consisting of liquid solutions,liquid suspensions and liquid dispersions.
 7. The fat-solubleanti-fungal composition of claim 6, wherein said composition is a liquidsolution.
 8. The fat-soluble anti-fungal composition of claim 1, whereinsaid fat-soluble carrier system further contains one or more additionalterpenoid components containing pinene.
 9. The fat-soluble anti-fungalcomposition of claim 1, wherein each of the mineral oil and turpentineare present in an amount of from 5-30% by weight, based on totalcomposition amount, and each of the one or more fat-soluble anti-fungalessential oils are present in an amount of from 1-7% by weight, based ontotal composition amount.
 10. The fat-soluble anti-fungal composition ofclaim 1, wherein said fat-soluble carrier system further comprisescamphor in an amount of from 0.1 to 10% by weight.